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In Vivo Analysis of the Anatomical Relationship of Coronary Sinus to Mitral Annulus and Left Circumflex Coronary Artery Using Cardiac Multidetector Computed Tomography

Implications for Percutaneous Coronary Sinus Mitral Annuloplasty

Arti J. Choure, MD^_*, Mario J. Garcia, MD, FACC^_*, Barbara Hesse, MD^_*, Matthew Sevensma, DO^_*, George Maly, MD, Neil L. Greenberg, PhD^_*, Lynn Borzi, RN, MBA^_*, Stephen Ellis, MD, FACC^_*, E. Murat Tuzcu, MD, FACC^_* and Samir R. Kapadia, MD, FACC^_*,_*

^_* Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Department of Radiology, Cleveland Clinic, Cleveland, Ohio.

View larger version (50K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Measurement of the distance between the mitral annulus and coronary sinus in standard 2-dimensional planes in (A) 4-chamber view; (B) 2-chamber view; and (C) 3-chamber view. RA = right atrium.

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Reconstructed 3-dimensional image of mitral annulus (MA), coronary sinus (CS), coronary arteries, and aorta. (Point a) Mitral annulus diameter in 4-chamber view (4C). (Point b) Mitral annulus diameter in 2-chamber view (2C); and (point c) Mitral annulus diameter in 3-chamber view (3C). All MA to CS measurements obtained in 2-dimensional images. LCX = left circumflex coronary artery.

View larger version (71K): [in this window] [in a new window] [Download PPT slide]   Figure 3 (A) Mapping of coronary sinus (CS) in 2-dimensional view. (B) Reconstructed 3-dimensional image showing the left circumflex coronary artery crossing "under (or deep to)" the CS.

View larger version (74K): [in this window] [in a new window] [Download PPT slide]   Figure 4 (A) Mapping of the coronary sinus (CS) in 2-dimensional view. (B) Reconstructed 3-dimensional imaging showing the left circumflex coronary artery crossing "above (or superficial to)" the CS.

View larger version (108K): [in this window] [in a new window] [Download PPT slide]   Figure 5 Reconstructed 3-dimensional image showing the distance from the ostium of coronary sinus to the intersection with left circumflex coronary artery.